Demons (14 page)

I’ve got one, said Megan.

It was just after three; there were two bottles left. They agreed to wait before
they opened the first. A pot of tea was made, and the tray set on the low table.

I thought about this before, said Megan, when we were talking about getting old.
I didn’t think it was a story but now after listening to the others I guess it is.
Anyway, I haven’t been able to think up another.

I personally think it’s one of the big issues of our time. (She was prefacing the
work a little more seriously than had seemed necessary till now.) I mean, we can’t
ignore the fact that the hospital system is in chaos, under-funded, crisis-ridden,
while millions of us are preparing to book ourselves in. Anyway, said Megan, I got
this story from the horse’s mouth, so to speak, last year when I was on my way up
to the Territory. I drove up, in a hire car—Evan, you know all this—so I could take
a few shots along the way: Flinders Ranges, Lake Eyre, the Centre. I’d hired it for
a month. I was going to take it at a leisurely pace to Alice, spend two weeks out
at Yuendumu, then drop the car back at Alice and fly home. Everything was going nicely,
I’d spent two nights at Eyre (I’ve got to show you guys the photos some time, it
was stunning) and was on the road from there to Oodnadatta when in the middle of
nowhere, out of mobile range, the car blew up. I say the middle of nowhere, but in
fact I wasn’t waiting long by the side of the road with the bonnet up when a car
appeared in the distance.

So anyway, said Megan, as I say, this car pulls up—late model, green, I’m not good
with cars—driven by a woman about my age who said she was going the same way. Her
name was Abbie. I told her what had happened and we decided it would be best to leave
my car there and ring the hire company when we got to Oodnadatta where we reckoned
there’d be mobile reception for sure. I put a note under the wiper with my number
at the bottom. I got my stuff, put it in Abbie’s car and off we went.

Lesbian sex in the desert, said Evan.

Abbie was a nurse, said Megan, giving Evan neither oxygen for his first joke nor
the time to tell a second, and as it turned out she was on her way from Melbourne
to the remote community of Lajamanu, west of Tennant Creek, to work in the health
clinic there. I can take you most of the way, she said. Why don’t you cancel the
hire car when we get into town, get a refund then come with me as far as Alice and
bum a lift to Yuendumu? It sounded like a good idea; I’d save myself a couple of
thousand dollars and avoid having to do the whole thing on my own. They’re long roads
out there, and nothing much to see.

Megan picked the story stick up off the table.

It didn’t take long to get talking, she said—Surprise, surprise, said Evan—and I
told her about what I did and how I was heading out there to follow up on that doco
and exhibition I did about the first anniversary of
Sorry
, to see what things were
really like all these years later. Get the local folk to talk to camera, tell their
stories, shoot it straight.

Anyway, we kept talking. Abbie tells me she’s single, has been a nurse all her working
life and is heading out to Lajamanu to make a new start because of all the crap going
down in the hospital where she used to work. She was a big woman, with a plain face
and a big brown mole on her cheek; her hair was short, less than a crew cut, like
it had been shaved. She saw me looking at it. A long story, she said. Then she stared
out the windscreen, like the story unravelling in her mind was as long as the road
ahead. Well, I said, pointing. Abbie laughed. Yeah, all right, she said.

Megan: Waiting Lists…

I don’t know if you know, Megan, said Abbie, how hospitals work—or don’t work, as
the case may be—but sadly these days they’re not much more than get well factories.
Sick people come in, we fix ’em up as quickly and cheaply as we can, and out they
go again. There’s not much time for any of that Florence Nightingale stuff.
Key Performance
Indicators
, that’s the mantra: people are numbers, even sick people. Especially sick
people. It’s an obsession. I don’t know when it started—it’s already lost in the
mists of time—but someone at some point decided that the way to improve a screwed-up
health system was to ask the bean counters to make it more ‘efficient’.

It became a numbers game. The government put a carrot in front and a stick behind:
move the patients through faster and you’ll be rewarded, slower and you’ll be punished.
And you see, Megan, in my opinion, the way the modern human being is made, you’re
always going to be more focused on getting the reward than copping the punishment:
people will take all kinds of crap, as long as there’s a tax break, an interest-rate
drop, a performance bonus. It’s like the dog getting whipped and then given a little
crunchy treat. Doesn’t matter how much pain it’s suffered, the master—
its master
—has
given it a little crunchy treat. For free. Or so it thinks.

Abbie had an easy way of talking, a soft voice, like someone who’s always had to
move quietly through the corridors and rooms. She talked without looking at me, her
eyes on the road, but her body language said she was getting ready to share something,
that I wouldn’t need to prompt her, ask questions or anything like that. And I was
happy to listen.

Because, she was saying, as we know, nothing’s for free in this world, there’s always
someone owed something. At the hospital where I worked, this exchange had been going
on for years: you reduce your waiting lists and we’ll give you commensurate funding.
One patient off the list?
Ker-ching
. Two patients?
Ker-ching
,
ker-ching
. The more
patients we get rid of, the more government money we’ll get to make improvements
to the system. There was only one catch: we
couldn’t
reduce our waiting lists. For
every branch you pruned off the top, two more roots would grow at the bottom. We
had to move the patients through faster but, without more funding, how were we going
to do that? A lot of us were working up to sixteen-hour shifts, getting rid of patients
as fast as we could, but the place was still chronically underfunded. It felt like
we were going to go around in this circle forever.

Then one evening, when things had finally gone quiet after a terrible day, we were
standing around the nurses’ station talking and someone said, sort of off-the-cuff:
If only we had a few patients we could get rid of quickly, then we might start to
get in front.

What if, for example, said Beckie—a lovely girl, enthusiastic, committed—we discharged
ten patients tomorrow morning instead of two? When we submit our monthly figures
that would mean a five-fold increase in our funding. But how do we do that? someone
asked. Find some patients who aren’t that sick, said someone else. Or, said another,
who aren’t sick at all. And how do we do that? I asked.

Listen, said Beckie, lowering her voice, I’ve been thinking. We make up
fake
patients,
add them to the list—hip replacement, gall bladder, skin cancer, whatever—move them
up as we normally would until they reach the top, then we treat them, report on them,
and discharge them. I’ve spoken to Heather in admin, said Beckie, still whispering,
and she says it’s a walk in the park. We start with a few, so it doesn’t look odd;
just a bit more stress than usual. More diagnoses, more referrals. But we’re nurses
in the public health-care system, she said, smiling; we rise to the occasion, don’t
we? So, on top of the massive number of patients we’re already moving through, we
somehow manage to move these new ones through too. And then, when the numbers go
up again, we miraculously step up and move them through as well. And for every patient,
a payment. We’ll play them at their game, ladies, because we know for them it
is
one. We’ll treat more or less the same number of
real
patients, but we’ll have more
money to do it: we’ll be able to give them more attention, better care, treat them
like human beings, all the things we came into the profession for. A deceitful act,
said Beckie, but done for the greater good.

Well, said Abbie, continued Megan, what could we say? It was a no-brainer. None of
us had to look too deep into our consciences to agree that in this case the end justified
the means. There were five of us at the nurses’ station that evening, plus Heather
upstairs: we all had the computer access and know-how we needed to pull it off. In
fact, it was almost
too
easy. To the hospital bosses, patients had become so many
figures in a column, a long way from the pissing, shitting, farting, sweating, bleeding,
suppurating bodies we had to deal with every day. They were never going to know whether
Jill Blow, for example, liver patient, really
had
been in Bed 12, 3 East. How were
they
ever going to know that?

Abbie turned and looked at me, said Megan, with a huge grin on her face, and in that
moment I got some idea of the buzz those nurses must have felt when they huddled
together talking that night.

So, Abbie continued, at first we just added a couple of phantom patients to the records.
We gave Heather the details and she dropped them into the system. The ‘patients’
worked their way up the list, Heather let us know when their appointment times had
been ‘sent’, then on the appointed day we ‘admitted’ them. They were elective surgeries
mostly, simple stuff, in and out in a day or two. No-one knew they didn’t exist.

We called ourselves the gang of six and we all had our areas of expertise and allotted
tasks. The key early members were me, Beckie, her friend Ange, Heather, Lisa, who
liaised with our contacts in Emergency so we could start taking patients from there,
and Keely, who was doing an evening writing course and volunteered to create the
patients for us, their names, backgrounds, medical histories and treatments. Patrick
Henshaw, male, 52, married, two children, history of gallstones, attacks more frequent
and severe, admitted 2 North Monday 15 October, discharged Wednesday 17. The first
week went well, a couple of voluntary patients in and out without incident, and on
Friday we all went out to celebrate. The next week we increased the numbers slightly
and, again, everything went smoothly. Our project was underway.

It’s incredible, when you think about it, said Abbie, what five nurses and an administrative
assistant in a public hospital could get away with. The following week, and the week
after that, we increased the numbers again. It was too easy. Of course we weren’t
doing this for any selfish reasons, there was nothing in it for us personally, and
ironically the extra funding in the first instance went straight into the pockets
of the bosses upstairs through performance bonuses. But the side effect was that,
in the eyes of the hospital, we were turning ourselves into saints and martyrs. Somehow,
we were keeping on top of this spike in admissions and still giving the best patient
care possible. Within the first few months of the first phantom patient being admitted
we were, the records showed, handling an almost seven per cent increase in admissions
overall, with no visible decline in patient care. An administration email went around
congratulating the nursing staff on dealing with the extra workload with great professionalism
in these, they said, ‘trying times’. We printed this email out and stuck it up in
the nurses’ station and that Friday night at our usual gathering we drank the best
champagne we could buy.

Then we ramped it up. By March last year we were pushing through anything up to
seventy extra patients a week. It was like a well-oiled machine. The bean counters
upstairs had no choice but to reward us—they were the ones who’d set the rules. At
the beginning of the next month, on our ward alone, we were given a new ECG unit,
a new defib, three new sphygs plus a whole bunch of new bibs and bobs we’d been requesting
for over a year. That week there was a real bounce in our step as we went about our
rounds.

But then things got complicated. The union was looking at the figures too. Here was
hard evidence, they said, for the case we’ve been arguing for years about better
pay and conditions. The system’s in crisis, nurses are bearing the brunt. Staffing
levels must be increased, workloads reduced, and pay rises awarded across the board.
Fat chance, said the hospital administrators and the government, so the union started
ratcheting things up.

Under any other circumstances this would have been a good thing—we were all members,
it was a hard-working union and it deserved our respect—but the trouble was, all
this agitation was putting the spotlight on our little ‘project’. The administrators
started asking questions. Our friends in Emergency were under the hammer enough without
the auditors sniffing around: Lisa told us she wanted out. We replaced our phantom
Emergency patients with phantom elective-surgery patients instead. These lists were
slower—to be honest they moved like glaciers—but they were an easier place to bury
our lies. Then the auditors started sniffing around our ward too.

We all met, I remember, at the pub that Friday, at our usual table in the corner
up the back, to discuss the situation. Ange had got cold feet too. I was prepared
to let her go—I was having second thoughts myself—but Beckie called her a coward
and reminded her of what we’d already managed to do. But Ange wouldn’t be moved.
She said we needed to stop now while we could—we’ve proved our point, isn’t that
enough? But sometimes, said Beckie, you’ve got to stand up for what you believe in.
And when you get caught? asked Ange. Caught for what? asked Beckie. What have we
done wrong? Ange shook her head. By the time the meeting in the pub adjourned that
night our gang of six was a gang of four.

Abbie pointed at a roadhouse in the distance. Are you hungry? she asked. She put
her indicator on. I need to get petrol. There were three or four trucks in the carpark,
and a couple more along the verge. We found a spot and went inside.